Multidisciplinary management of postoperative duodenal perforation using multiple drainage and stenting: A case report and review of literature

Figure 2 Surgical illustrations. A and B: First operation: Multiple soft tissue tumors of the colonic mesentery and the right hemicolon were resected. The larger tumor was tightly adherent to the lateral wall of the duodenum; B and C: Second operation and intervention: Intraoperative exploration revealed a perforation on the anterior wall of the horizontal portion of the duodenum. The perforation was repaired with sutures and reinforced using a ligamentum teres hepatis patch. Gastroenteric and biliary diversions were created, and a feeding jejunostomy tube was placed. Postoperative examination indicated persistent unhealed duodenal perforation, and a covered duodenal stent was placed over the perforation site; C and D: Third operation: A duodenostomy tube was directly placed at the perforation site and secured with a wrap of the ligamentum teres hepatis. Additionally, a paraduodenal drain with irrigation and suction capabilities was placed. CT: Cholecystostomy tube; NT: Nasogastric tube; CDS: Ccovered duodenal stent; RDT: Retrograde duodenal decompression tube; PJ: Percutaneous jejunostomy tube; DT: Duodenostomy tube; IDT: Irrigable drainage tube.